Arthropathy of the shoulder joint

One third of all seniors over the age of sixty report pain in the shoulder joint. The cause of pain in this area in most cases is the development of arthropathy. The disease also affects young people whose occupation involves constant intense physical activity - miner, builder, loader, etc.

The disease causes great inconvenience in everyday life and sharply reduces the ability to work. In severe cases, shoulder arthropathy leads to disability. It is important to detect the disease in the early stages. There are now treatment methods that suppress the progression of the disease when treatment is started early.

What is pathology

Shoulder joint arthropathy is a chronic disease in which degenerative processes destroy and thin the cartilage. Osteoarthritis of the shoulder is classified as a group of pathologies that are not infectious in nature. First, the cartilage tissue that covers the joint surfaces is destroyed.

Cartilage loses its strength and elasticity. It gradually thins and straightens. Due to changes in the cartilage layer, it loses its shock-absorbing properties. Its ability to reduce impact loads that occur during arm flexion or extension is impaired.

Osteoarthritis also affects all structures, such as the joint capsule, its shell, the surfaces of the bones adjacent to the cartilage layer, the ligaments and the adjacent muscles. This is accompanied by pathological changes in other soft tissues located near the joint. As a result of the disease, bony growths form on the joint surfaces.

The pathology is manifested by pain and tingling in the area of the affected shoulder. In the later stages of the disease, the range of motion in the shoulder joint is sharply reduced. Inflammation in it with this nature of the process is either absent or weakly expressed. The pathology has a chronic, gradually progressive course.

Reasons

The cascade of pathological changes in osteoarthritis is triggered by natural tissue aging. Cartilage damage as a result of strong mechanical stress can contribute to the initiation of cartilage destruction. This is also facilitated by various pathological processes.

Primary shoulder arthropathy is usually diagnosed in older people. Secondary joint damage develops in the context of previous diseases. It occurs at any age. The main causes of the disease are considered to be:

1. Developmental abnormalities. The pathology is often found in patients with underdevelopment of the humeral head or glenoid cavity, as well as in the presence of other defects of the upper limb.
2. Injuries. Traumatic arthropathy often develops after intra-articular fractures. Sometimes the cause of the pathology is a dislocation of the shoulder, most often an ordinary one. Occasionally, severe bruising causes the development of pathology.
3. Inflammation. Arthropathy often occurs when a patient has suffered from glenohumeral periarthritis for a long time. This is also facilitated by non-specific purulent arthritis suffered in the past, as well as specific damage to the joints resulting from tuberculosis, syphilis and other diseases.

There is a group of risk factors that contribute to the occurrence of such a multi-etiological disease. The following phenomena increase the likelihood of arthropathy:

• Genetic predisposition. Close relatives of many patients also suffer from arthropathy. They also have faults with other localizations. The knee, ankle and other joints are usually affected.
• Hypertension. It often occurs in athletes involved in volleyball, tennis, basketball and throwing sports equipment. This condition also occurs in people if their profession is characterized by a constant high load on the upper extremities (loaders, miners and others).
• Illnesses. Osteoarthritis often develops in patients suffering from autoimmune joint diseases. Certain endocrine diseases, metabolic disorders and connective tissue deficiency, characterized by excessive joint mobility, also contribute to degenerative processes in the cartilage.

The incidence of degenerative joint lesions in patients increases sharply with age. Frequent hypothermia also negatively affects the joints.

Symptoms

At the onset of the disease, patients with arthropathy feel discomfort and moderate pain in the shoulder area. There is a dependence of pain on the weather. They become more intense after physical activity. Pain intensifies in a specific body location. After resting or changing position, the pain disappears.

When the patient moves his arm, a tingling sensation occurs. There are no external changes in the joint, no swelling. Over time, the pain becomes more intense. It constantly bothers the patient, regardless of the position of the body. Pain has a pulling or aching character.

Pain in the shoulder joint becomes common and constant. Painful sensations occur both during exercise and at rest. They can disturb the patient at night. The characteristic features of pain syndrome in osteoarthritis of the joint are the following:

• along with the appearance of pain over time, acute pain occurs during physical activity.
• unpleasant sensations are recorded only in the joint area, it radiates to the elbow area, and then it can spread to the entire surface of the arm.
• The pain may spread to the back and neck on the affected side.

After a short time, the patient is bothered by morning stiffness in the shoulder. The range of active movements in the joint is reduced. After physical activity, as well as hypothermia, slight swelling of the soft tissues in the shoulder area is detected.

As joint damage progresses, there is an increase in range of motion limitations. The patient develops contracture (stiffness), which significantly impairs the function of the limb. If the osteoarthritis is on the right side, the patient cannot take care of himself.

Stages of development

With this disease, there are three stages of the pathological process in the joint. They reflect the severity of the damage to the articular structures and the presence of certain symptoms of damage to the shoulder joint. Experts distinguish the following stages of the pathological process:

1. First. The absence of gross structural changes in the thickness of the cartilage tissue is noted. The composition of the intra-articular fluid changes. Cartilage nutrition is disturbed. He does not tolerate stress well, which leads to periodic pain.
2. Second. At this stage, thinning of the cartilaginous tissue occurs. Its structure changes. The surface becomes rough. Cysts form in the thickness of the cartilage layer and foci of calcification appear. Areas of bone adjacent to the joint are moderately deformed. The edges of the articular platform are covered with bony growths. The discomfort becomes constant.
3. Third. An intense degree of thinning of the cartilaginous layer and disruption of its structure is noted. Extensive areas of cartilage destruction are identified. A significant deformation of the articular platform is found. Range of motion limitation is revealed. Weakness of the ligaments is observed, as well as a reduction in the size and flaccidity of the periarticular muscles.

This approach to the classification of shoulder joint injuries allows doctors to choose appropriate treatment tactics that take into account the severity of the pathological process.

Diagnostics

The appearance of arthropathy symptoms forces the patient to go to the doctor. He needs to see a therapist. The specialist will make an initial diagnosis. After determining the cause of the joint damage, he will refer the patient to a rheumatologist, endocrinologist, surgeon or orthopedic traumatologist.

Doctors make the diagnosis in the presence of typical clinical manifestations and joint signs with X-rays. During the initial examination, the tissues of the joint are felt to determine the degree of pain.

The possibility of making active and passive movements in the affected area is studied. The doctor detects deformation of the joint or an increase in its volume. To confirm the presence of arthropathy, the following studies are recommended:

1. X-ray. In the joint, the presence of dystrophic changes in the cartilage layer is detected. Characteristic bone growths are found along the edge of the joint cavity. At a later stage, they find that the joint space is narrow. A change in the shape and structure of the bone adjacent to the cartilage is identified. The shape of the joint space becomes wedge-shaped. In the thickness of the bone, signs of thinning and the presence of cyst-like formations are visible.
2. The CT scan. This study in the early stages of the disease provides an opportunity to assess the state of bone and cartilage using layer-by-layer images.
3. Magnetic resonance imaging. The method assesses the condition of soft tissue formations (cartilage, ligaments, joint capsule, etc. ). Clear layer-by-layer images help determine the extent of damage to articular and peri-articular structures.
4. Ultrasound. Changes in the joint are detected by ultrasound. The method is safe for the body, as there is no harmful radiation.
5. Arthroscopy. It is performed using an endoscope. An operator with a camera is inserted into the joint. The doctor clearly sees the areas of damage. Softening zones are defined in the thickness of the cartilage. It reveals the presence of deep fissures that penetrate deep into the subchondral (subchondral) plate of the bone. Deep cartilage ulceration, erosion and superficial cracks are detected.

Diagnosis of arthrosis of the shoulder joint in the later stages presents no difficulties for doctors. When assessing the nature of joint damage, it is necessary to take into account the possible secondary origin of joint pathology in relation to other diseases.

Treatment

Treatment for osteoarthritis is carried out by orthopedic traumatologists or rheumatologists. At the stage of restoration of motor functions, rehabilitation specialists are actively involved in the treatment process.

To relieve pain and restore function in a sprained limb, it is important to get prompt medical attention and follow all doctor's orders. It is necessary to limit the load on the joint and avoid sudden movements of the hand. It is important to avoid lifting or carrying heavy objects for long periods of time.

The joint needs dosage load under the supervision of specialists, as complete inactivity has a negative impact on the affected limb. Treatment options include conservative treatment and surgical interventions. The choice of methods depends on the prevalence of certain symptoms and the stage of the disease.

Pharmacotherapy

An important goal in the treatment of arthritis is the elimination of pain. To eliminate discomfort and reduce the severity of inflammation, the following drugs are prescribed:

1. Preparations for general anesthesia. NSAIDs are prescribed to patients for a short course during an exacerbation. With prolonged uncontrolled use, they irritate the gastric mucosa and slow down the recovery process in the joint.
2. Topical treatments. Gels and ointments containing non-steroidal anti-inflammatory compounds are used when symptoms increase. Medicines containing hormones with local action are used less often. They relieve inflammation and swelling.
3. Means for intra-articular injections. For persistent and severe pain that cannot be eliminated by other means, glucocorticoid drugs are injected into the joint. Blockings can take place no more than four times a year.

In the first and second stages, chondroprotectants are prescribed to restore and strengthen the joint. These products contain chondroitin sulfate, hyaluronic acid and glucosamine. They are used in long runs of six months or more. The effect of the treatment is felt only after three months of continuous use of the drug.

In addition, vasodilators are used for shoulder arthropathy. They increase blood flow and relieve capillary spasms. Muscle relaxants are prescribed to relax the muscles in the shoulder area when spasms are detected.

Surgical methods

In the third stage of arthrosis, when there is significant destruction of the joint with limited mobility and loss of working capacity, endoprosthetic surgery is performed. Age, physical activity level and general health are taken into account before deciding whether to have an intervention.

Placing modern endoprostheses made of ceramic, plastic and metal completely restores the function of the joint. The devices have a guaranteed lifespan of more than fifteen years.

Non-pharmacological treatment

Physiotherapy techniques are actively used in the phase of subsidence of the exacerbation in the treatment of osteoarthritis of the joints. Their use along the way gives good results when included in a complex treatment program. The following physiotherapeutic methods are used for arthropathy:

1. Enhancement. The treatment method affects the joint locally using alternating electric current. It relieves pain and has a vasodilating effect. The process improves tissue nutrition.
2. UHF. The joint is exposed to extremely high frequency waves. The method reduces pain, relieves inflammation and swelling.
3. Magnetic therapy. Joint structures are affected by a pulsed magnetic field. Improves blood flow. Cartilage is saturated with nutrients. The magnet removes the decay products from the cells. Suppresses autoimmune reactions.
4. Electrophoresis. This technique promotes the penetration of drugs into the affected joint, which is ensured by the effect of electric current on the tissue. During treatment, blood flow to the joint structures increases. The procedure reduces inflammation and swelling. Unpleasant sensations in the hand are relieved. Muscle spasm is eliminated.
5. Bath therapy. Therapeutic baths with radon, saline and other beneficial solutions are actively used for shoulder arthropathy. Blood flow improves, which boosts nutrition and accelerates cell recovery. Inflammation is relieved.
6. Electrical stimulation. With this method of treatment, electrical stimulation of the nerve trunks and muscles is carried out using electrodes, which transmit a current that has specific parameters.

Therapeutic massage is performed after the flare-up has subsided. It restores the blood flow and increases the elasticity of the ligaments. Muscle spasm in the joint is reduced. Range of motion increases. For arthropathy, exercise therapy is helpful.

The gymnastics complex is performed when the pain subsides. When conducting mechanical therapy, special simulators are used for rehabilitation. Active-passive movements are carried out in them. They restore the function of the affected joint.

How to cure at home?

Laser therapy is considered an effective method in the treatment of shoulder arthropathy. The laser beam has a beneficial effect on the affected tissue of the joint. Devices that produce low intensity infrared laser rays are used for treatment. Laser therapy is prescribed to accelerate cell metabolism.

All physicochemical reactions are stimulated in the tissues. Cartilage cell functions are activated. Laser therapy provides an analgesic effect. Blood flow improves and swelling is eliminated. Local immunity is strengthened. Reserve capillaries expand. Laser therapy has an anti-inflammatory effect.

To receive procedures, you do not need to constantly visit a medical facility. Treatment of shoulder arthritis at home is carried out using portable laser therapy devices. With their regular use, the pain is reduced. Shoulder joint function improves with home laser arthritis treatment.

Prognosis and prevention

Shoulder arthropathy cannot be completely cured. But it is possible to slow down the progression of pathological changes in the joints. With regular treatment, the ability to work is maintained. It is important to follow the doctor's recommendations.

It is necessary to avoid injury to the hand. It is important to avoid excessive impact on the shoulder joint when performing professional tasks, as well as during sports. It is necessary to treat diseases that contribute to the development of arthropathy in a timely manner.